Moderate to severe depression has been said to occur in around 20% of cancer patients. However, this disorder is seldom recognized or treated in this group of patients. The purpose of the proposed project is twofold. First, we will ascertain by means ofclinical interview and psychological evaluation, the prevalence and severity of depression among females with cancer treated at the University of Kansas Medical Center. Second, we will evaluate the effectiveness of antidepressant medication (nortriptyline) in alleviating depression among cancer patients. Women with breast or gynecologic (ovarian, endometrial, vulvar, and cervical) cancer will be identified and screened for depression. Patients who are positive for depression on the Psychiatric Diagnostic Inventory (PDI), have scores of greater than 50 on the Zung Self-Rating Depression Scale and greater than 20 on the Hamilton Depression Rating Scale will be classified as depressed. Those with normal EKG's and liver function tests will be randomly divided into two groups, a nortriptyline treatment group and a placebo group. Administration of the drug and placebo will be double blind. Treatment will continue for six weeks, with weekly monitoring of plasma nortriptyline levels, side effects, ans psychological re-evaluation with the Zung, Hamilton and Karnofsky scales. Data will be analyzed to assess change in depression scores with treatment. Discriminant function analysis will be utilized to identify variables associated with depression per se and with response to nortriptyline treatment. Such variables will include demographic (age, family constellation, educaton, occupation) and illness (diagnosis, stage of illness, time since diagnosis, type of cancer treatments, Karnofsky Performance Level) factors. The relationship between plasma nortriptyline levels and therapeutic response will also be analyzed.